Outcomes of an integrated community-based nurse-led cardiovascular disease prevention programme

Abstract

Background: National guidance for England recommends that cardiovascular disease (CVD) should be managed as a family of diseases in the community. Here we describe the results of such an approach. Methods: Patients with established CVD (CVD) or who were at high multifactorial risk (HRI) underwent a 12 week community-based nurse-led prevention programme (MyAction) which included lifestyle and risk factor management, prescription of medication and weekly exercise and education sessions. Results: Over a 6 year period 3,232 patients attended an initial assessment, 63% were male and 48% belonged to black and minority ethnic groups. 56% attended an end of programme assessment and 33% a one year assessment. By end of programme, there was a significant reduction in smoking prevalence but only in HRI (-3.7%, p<0.001). Mediterranean Diet Score increased in both CVD (+1.2, p<0.001) and HRI (+1.5; p<0.001) as did fitness levels (CVD +0.8 estimated Mets maximum, p<0.001, HRI +0.9 estimated Mets maximum, p<0.001) and the proportions achieving their physical activity targets (CVD +40%; p<0.001, HRI +37%; p<0.001).There were significant increases in proportions achieving their BP (CVD +15.4%; p<0.001, HRI +25%, p<0.001 and LDL-cholesterol targets (CVD +6%, p=0.004, HRI +23% p<0.001). Statins and antihypertensive medications significantly increased in HRI. Significant improvements in depression scores and quality of life measures were also seen. The majority of improvements were maintained at one year. Conclusion: These results demonstrate that an integrated vascular prevention programme is feasible in practice and reduces cardiovascular risk in patients with established CVD and in those at high multifactorial risk